Anxiety: current practices in assessment and treatment of anxiety of burn patients.

Robert R, Blakeney P, Villarreal C, Meyer WJ 3rd.

The University of Texas Medical Branch and Shriners Burns Hospital, Galveston, TX 77550, USA. rrobert utmb.edu

Anxiety is an affective response commonly experienced by persons after emotional and physical trauma, as well as associated with aversive medical treatments. The scientific information related to the conceptualization, assessment, and treatment of anxiety is limited. In order to develop a pilot protocol for anxiety management, nursing directors at 64 burn centers were surveyed. At 89% of the centers, anxiety measures were not used. Most of the teams assess informally through observation of patient (n=21), dialogue with patient (n=12), or both observation and dialogue with patient (n=15). Assessors of anxiety range in breadth from nurse only to the entire burn team, including pastoral care representatives and family. The class of medication most frequently endorsed in treating anxiety is the benzodiazipine, most often lorazepam (Ativan). A number of non-pharmacologic techniques are used to manage anxiety, e.g., muscle relaxation, breathing, imagery. Consideration should be given to assessing anxiety systematically, so knowledge can be gleaned and applied to conceptualization of symptom presentation and application of treatment resources.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10869826&dopt=Abstract anxiety medicine




Anesthetic assessment in an outpatient consultation clinic reduces preoperative anxiety.

Klopfenstein CE, Forster A, Van Gessel E.

Department of Anaesthesiology, Clinical Pharmacology and Surgical Intensive Care, University Hospitals, Geneva, Switzerland. Claude-Eric.Klopfenstein hcuge.ch

PURPOSE: Preoperative anxiety in relation to anesthesia remains for many patients a major subject of concern. The aim of the present study was to compare the level of preoperative anxiety in patients assessed in an outpatient consultation clinic with the anxiety level of those having been assessed by the anesthesiologist after entering the hospital. METHOD: We studied two groups of 20 patients who underwent elective transurethral prostate or bladder resection: group A having the anesthetic assessment between one-two weeks before hospitalisation, group B having this assessment the evening before surgery, after entering the hospital. Two different methods to assess anxiety were used: the Multiple-Affect-Adjective-Check-List (MAACL) and the visual analogue scale of anxiety (VAS). RESULTS: Both anxiety provided scores, assessed by two different methods, were lower in group A, than in group B(P<0.01). CONCLUSION: The results of this study confirm that an anesthetic assessment in an outpatient consultation clinic reduces preoperative anxiety, when compared with an assessment on the evening before surgery.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10875713&dopt=Abstract anxiety medicine




Effects of anxiety and depression on 5-year mortality in 5,057 patients referred for exercise testing.

Herrmann C, Brand-Driehorst S, Buss U, Ruger U.

Department of Psychosomatics and Psychotherapy, University of Gottingen, von-Siebold-Strasse 5, D-37075, Gottingen, Germany. cherrma gwdg.de

OBJECTIVE: Beyond acute myocardial infarction, little is known about the effect of depression, and especially anxiety, on prognosis in cardiology patients. The present study aims to examine the effect of anxiety and depression on 5-year mortality in patients referred for exercise testing. METHODS: A total of 5,057 patients referred for routine exercise testing completed the Hospital Anxiety and Depression Scale (HADS) before undergoing the exercise test. Survival data were obtained from 5,017 (99.2%) of those patients after 5.7 +/- 0.8 years. HADS scores and cardiological baseline data were used to predict mortality. RESULTS: In univariate analyses, HADS depression was not a significant predictor; high anxiety was associated with improved survival. Logistic regression revealed nine independent objective predictors from which we computed a composite somatic risk index. When controlling for this physical risk index, anxiety and depression had independent, opposite effects; that is, anxiety was associated with a lower mortality and depression with a higher mortality. CONCLUSION: Anxiety and depression scores have different predictive effects on mortality in patients referred for exercise testing. These effects are independent of a highly effective physical risk index, suggesting that psychological screening of cardiology patients might improve risk stratification.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10880666&dopt=Abstract anxiety medicine




Subthreshold depressive and anxiety disorders in the elderly.

Heun R, Papassotiropoulos A, Ptok U.

Department of Psychiatry, University of Bonn, Venusberg, D-53105 Bonn, Germany.

The aims of the present study were to compare the current and lifetime prevalences for major and subthreshold affective disorders in elderly subjects in the general population, to assess the influence of demographic variables on prevalence rates, and to examine co-morbidity between these disorders. Major and subthreshold disorders were diagnosed in 286 subjects (aged >/= 60 years). Four-point-nine percent of the subjects had a lifetime diagnosis of major depression, 31.8% either minor or recurrent brief depression, 6.6% a major anxiety disorder, and 18.5% a subthreshold anxiety disorder. The risk for current and lifetime subthreshold anxiety was higher in females than in males, the lifetime prevalence for subthreshold anxiety disorders was increased in elderly subjects and subjects with low professional levels. Increased co-morbidity between major and subthreshold depressive and anxiety disorders could not be observed. In the elderly, subthreshold depressive and anxiety disorders are frequent, more so than major affective disorders. The presence of subthreshold anxiety disorders, but not subthreshold depression, is influenced by age, gender, and previous professional level. Further research focusing on detection, evaluation of risk factors and the relevance for the quality of life in the elderly general population is needed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10881214&dopt=Abstract anxiety medicine




The relationship between interpersonal sensitivity, anxiety disorders and major depression.

Wilhelm K, Boyce P, Brownhill S.

School of Psychiatry, University of New South Wales, Sydney, Australia.

BACKGROUND: While interpersonal sensitivity, as rated by the Interpersonal Sensitivity Measure (IPSM) has previously been found to be an efficient predictor of depression, there has been less interest in the relationship between the IPSM and anxiety disorders. This study examines the performance of the IPSM in discriminating between cases and non-cases of the various anxiety disorders. The contribution of depression and the perception of parental environment, to any relationships found, are also examined. METHODS: A cohort of 156 men and women has been assessed at 5-yearly intervals since baseline in 1978, in their last year of teacher training. In this fourth wave of follow-up, subjects completed a series of self-report questionnaires, including the IPSM, and scales measuring neuroticism and trait depression. Perceived parental environment, measured at baseline, was also included. DSM-III-R major depression and anxiety disorders were generated using the Composite International Diagnostic Interview. The IPSM subscales were moderately stable over time. 'Timidity' was associated with agoraphobia and simple phobia, and 'separation anxiety' with agoraphobia, panic disorder and generalised anxiety disorder. 'Separation anxiety' and 'timidity' showed differential gender effects for simple phobia. 'Fragile inner self' and 'separation anxiety' were associated with subjects with a history of repeated episodes of major depression, and the former, with perception of poor parental care. LIMITATIONS: The IPSM was not available for inclusion prior to the 1988 wave. CONCLUSIONS: While the IPSM subscales were consistently correlated with neuroticism, they displayed differential associations with specific anxiety disorders, episodes of major depression and early parental environment. These findings offer greater understanding of mechanisms concerning the relationship of vulnerability to anxiety disorders and depression.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15023478&dopt=Abstract anxiety medicine




[A study of employment anxiety in college women]

[Article in Japanese]

Fujii Y.

Iwate Prefectural University.

The purpose of this study was to develop "Employment Anxiety Scale" to understand the structure of anxiety accompanying employment seeking. First, 30 items of anxiety related to employment seeking were collected with an open-ended questionnaire, for which 65 female students answered. In the main study, 465 female undergraduates filled out a questionnaire of the thirty items, a stress scale, and a self-report depression scale. Factor analysis found three factors for the anxiety items: employment seeking activity, vocational aptitude, and workplace. Multiple regression analysis was performed to examine the relationship between the mental-health scales and the anxiety. The dependent variables were the stress and depression scores, and the predictors the subscale scores of Employment Anxiety Scale. Results showed that anxiety accompanying employment-seeking activity was highly predictive of the mental-health scores.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10756590&dopt=Abstract anxiety medicine




Does shy-inhibited temperament in childhood lead to anxiety problems in adolescence?

Prior M, Smart D, Sanson A, Oberklaid F.

Department of Psychology, Royal Children's Hospital, Parkville, Victoria, Australia. priorm cryptic.rch.unimelb.edu.au

OBJECTIVE: To assess the relationships between shy-inhibited temperament in childhood and anxiety problems in early adolescence using a prospective, longitudinal data set from a large community sample. METHOD: Relationships between shyness ratings on age-appropriate temperament scales and anxiety problems were analyzed, looking both forward and backward in time from infancy to adolescence. RESULTS: Forty-two percent of children rated as shy on 6 or more occasions over 8 surveys in childhood had anxiety problems in adolescence, compared with 11% who were never shy. Persistence of shyness and its presence in middle childhood increased risk for anxiety. A highly reactive temperament added to shyness did not increase the risk for anxiety. Few children with an anxiety diagnosis in early adolescence had a history of shyness. CONCLUSIONS: Prediction from childhood shyness to adolescent anxiety disorder is modest but clinically meaningful in a community sample. However, most shy children did not develop an anxiety disorder and most adolescents with anxiety disorders had not been especially shy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10761348&dopt=Abstract anxiety medicine




Concurrent modulation of anxiety and memory.

Wall PM, Messier C.

School of Psychology, University of Ottawa, Vanier: Room 215, Ottawa, Canada. pmwall uottawa.ca

We have previously shown that the ventromedial prefrontal cortex (vmPFC) is involved in spontaneous working memory and anxiety-related behaviour in CD-1 mice. Specifically, pretrial microinjection of the kappa(1) agonist, U-69,593, in the infralimbic (IL) area of the vmPFC produced a robust anxiolytic behavioural profile in the elevated plus-maze and enhanced spontaneous working memory in the Y-maze. In the present study we sought to determine whether these effects were specific to IL kappa receptors. We hypothesized that microinjection of the kappa antagonist, norBNI, in the IL cortex would influence anxiety and spontaneous memory in an opposite direction to the effects produced by the kappa(1) agonist. In week 1, transfer-latency reference memory and anxiety were tested in the elevated plus-maze in two separate trials with an intertrial interval of 24 h. In week 2, spontaneous working memory was tested in the Y-maze followed immediately by defensive/withdrawal anxiety in the open field for one half of the animals in each group, and the other half was tested in reverse order. Pretreatment with one injection of vehicle, 1, 5 or 10 nmol/0.5 microl norBNI in the IL cortex dose-dependently reduced transfer-latencies and produced an anxiogenic behavioural profile in the first elevated plus-maze trial. Following a 24 h delay, transfer-latency reference memory was not influenced, but a robust anxiogenic behavioural profile was observed in the second no-injection anxiety trial in the elevated plus-maze relative to control animals. In week 2, the same groups of mice were again pretreated with one injection of the same doses of norBNI in the IL cortex and tested in the open field and Y-maze. NorBNI pretreatment was anxiogenic in the defensive/withdrawal anxiety test and disrupted spontaneous working memory regardless of testing order. The present results show the influence of kappa receptor modulation on anxiety induction and spontaneous working memory. These results also support the hypothesis that immediate memory processing may modulate the induction of anxiety-related behaviours.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10762693&dopt=Abstract anxiety medicine




An evaluation of the factor structure and predictive utility of a test anxiety scale with reference to students' past performance and personality indices.

McIlroy D, Bunting B, Adamson G.

School of Behavioural and Communication Sciences, University of Ulster at Jordanstown, UK. D.McIlroy ULST.ac.uk

BACKGROUND: Scales of test anxiety have developed in parallel with the evolution of the test anxiety construct. A recently refined version of the Revised Test Anxiety scale offers the prospect of independently assessing different test anxiety factors. AIMS: The study aims to ascertain if the four-factor structure of the RTA scale found in Egyptian and American samples can be replicated in an Irish sample, and to examine the comparative predictive utility of cognitive and emotionality factors in relation to examination performance. The study also examines whether results support an Interference or Deficits Model of test anxiety, and assesses the relationship of test anxiety to personality variables believed to be relevant to academic performance. SAMPLE: The participants were 117 male and female psychology students from the University of Ulster. Their average age was 23 years. METHOD: Data were analysed using correlation analysis, multiple regression, factor analysis and ANOVA. Examination performance was the criterion variable; predictor variables were the four factors of test anxiety, three personality measures and previous examination performance. RESULTS: Four-factor test anxiety invariance across diverse population is supported by the model in the analysis. Cognitive factors are significant negative predictors of performance. The data do not support either an Interference or Deficits Model of test anxiety, and personality factors, especially self-efficacy, were significantly (negatively) related to test anxiety. CONCLUSIONS: The two cognitive factors have emerged as the most substantial negative predictors of examination performance. Attention to these factors and to relevant personality indices are commended as a potentially fruitful strategy for remedial intervention.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10765564&dopt=Abstract anxiety medicine